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Luna-Ortiz K, Reynoso-Noverón N, Zacarías-Ramón LC, Luna-Peteuil Z, García-Ortega DY. Role of Neck Dissection in Organ-Preservation for Glottic Squamous Cell Carcinoma. Indian J Otolaryngol Head Neck Surg 2022; 74:5865-5870. [PMID: 36742477 PMCID: PMC9895741 DOI: 10.1007/s12070-021-02470-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023] Open
Abstract
The surgical approach to the neck in laryngeal cancer depends on the tumor site and stage. Clinical practice guidelines recommend elective neck dissection in ≥ T2 N0 and all supraglottic cancers; however, there is no evidence supporting these recommendations. The objective is to evaluate the results of bilateral elective neck dissection in patients with glottic cancer who underwent supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). Thirty-five patients diagnosed with ≥ T2 N0 laryngeal squamous cell carcinoma (LSCC) in a single-center retrospective study. Right-sided neck dissections yielded 900 lymph nodes, none of which were positive for metastatic disease. Left-sided neck dissections yielded 949 lymph nodes, one of which was positive for malignancy. Prelaryngeal (Delphian) neck dissection was performed in all patients. Out of 50 lymph nodes removed; one was positive for malignancy. Median overall survival was 172 months, and the 60-month overall survival was 87.3%. The 60-month disease-specific survival was 97.1%. Bilateral neck dissection and Delphian node dissection showed a low rate of metastasis (2.8%). Radical neck dissection may thus represent overtreatment; however, this surgical procedure could be justified to prevent regional recurrences.
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Affiliation(s)
- Kuauhyama Luna-Ortiz
- Department of Head and Neck Surgery, Instituto Nacional de Cancerologia (Mexico), Av. San Fernando # 22, Col. Sección XVI, 14080 Tlalpan Mexico CDMX, Mexico
- Department of Surgery (Head and Neck Surgey), Hospital General Manuel Gea Gonzalez (Mexico), Mexico City, Mexico
| | - Nancy Reynoso-Noverón
- Basic and Clinical Research, Instituto Nacional de Cancerología (Mexico), Av. San Fernando #22, Col. Sección XVI, 14080 Tlalpan, Mexico City, Mexico
| | - Luis C. Zacarías-Ramón
- Department of Head and Neck Surgery, Instituto Nacional de Cancerologia (Mexico), Av. San Fernando # 22, Col. Sección XVI, 14080 Tlalpan Mexico CDMX, Mexico
| | - Zelik Luna-Peteuil
- Universitatea de Medicinâ Si Farmacie Grigorie T. Popa IASI (visitor medical student), Mexico City, Mexico
| | - Dorian Y. García-Ortega
- Surgical Oncology, Instituto Nacional de Cancerología (Mexico), Av. San Fernando #22, Col. Sección XVI, 14080 Tlalpan, Mexico City, Mexico
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Xu Y, He M, Liu Y, Wang Z, Yi J, Zhang Y. Delineation of neck node levels for patients with locally advanced supraglottic cancer receiving radical intensity-modulated radiotherapy: a cross-sectional study in Mainland China. Future Oncol 2022; 18:2475-2482. [PMID: 35703104 DOI: 10.2217/fon-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: To survey the diversity of clinical target volumes (CTVs) for locally advanced supraglottic cancer (LA-SGC) with radical radiotherapy in mainland China. Methods: Radiation oncologists from 30 provinces and four representative cases (T2N1, T3N2b, T4N0, T4N2c) were included. Results: High risk (HR)-CTV included involved and the lower adjacent level was followed by most physicians (n = 160, 97.6%). In the N0-1 stage, whether contralateral levels II-III should be included in HR- or low risk (LR)-CTV was controversial. In the N2 stage, the bilateral levels II-IVb were included in LR-CTV (75-92.5% agreement). Levels Ib, V or VIb were included in CTV requiring certain conditions. Conclusion: Involved and lower adjacent levels were as HR-CTV. Whether bilateral levels II-IV are included in HR- or LR-CTV remain controversial.
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Affiliation(s)
- Yi Xu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Meilin He
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Yang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Zekun Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.,Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
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3
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Wu Y, Zhang L, Tang T, Li L, Li L, Yu H. Postoperative Radiotherapy Omitting Level Ⅳ for Locally Advanced Supraglottic and Glottic Laryngeal Carcinoma. Technol Cancer Res Treat 2021; 20:1533033820985876. [PMID: 33517858 PMCID: PMC7871352 DOI: 10.1177/1533033820985876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Cervical lymph nodes metastases are one of the most significant prognostic
factors in patients with laryngeal carcinoma, whether treatment by surgery
or by radiotherapy. The current study retrospected the postoperative
radiotherapy of locally advanced supraglottic and glottic laryngeal
carcinoma (at a greater risk of lymph node metastasis) to determine the
effect of radiotherapy excluding cervical level Ⅳ lymph nodes. Methods: Patients of supraglottic type and glottic type were irradiated with level Ⅳ
from January 2012 to June 2013, without level Ⅳ from July 2013 to December
2014, according to physicians’ decision. Ninety-three patients were
selective neck irradiation (SNI) of levels Ⅱ-Ⅳ (Group A) and 87 patients
were SNI of levels Ⅱ and Ⅲ (Group B). The comparison between Group A and
Group B was made with observation of clinical risk of recurrence and
radiation complications, as well as overall survival (OS), progress-free
survival (PFS) and regional nodal recurrence-free survival. Results: No remarkable difference was observed in the distribution of recurrence,
levels of relapse, OS, PFS and regional nodal recurrence-free survival
between the 2 groups (p > 0.05). Mean radiation dose at level Ⅳ, thyroid
and cervical esophagus showed significant difference between the 2
therapeutic groups (p < 0.01). As regard radiation complications, no
significant difference was found in radiation dermatitis of any grade
between the 2 groups (p > 0.05). However, there was remarkable difference
in clinical hypothyroidism and radiation esophagitis between Group A and
Group B (p < 0.05). Conclusions: Radiotherapy after surgery omitting level Ⅳ may improve the quality of life
in patients with locally advanced supraglottic and glottic laryngeal
carcinoma, won’t worsen the prognosis as well.
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Affiliation(s)
- Yang Wu
- Department of Radiation Oncology, Xuzhou Medical University Affiliated Hospital, Xuzhou, People's Republic of China
| | - Longzhen Zhang
- Department of Radiation Oncology, Xuzhou Medical University Affiliated Hospital, Xuzhou, People's Republic of China
| | - Tianyou Tang
- Department of Radiation Oncology, Xuzhou Medical University Affiliated Hospital, Xuzhou, People's Republic of China
| | - Liantao Li
- Department of Radiation Oncology, Xuzhou Medical University Affiliated Hospital, Xuzhou, People's Republic of China
| | - Liang Li
- Department of Radiation Oncology, Xuzhou Medical University Affiliated Hospital, Xuzhou, People's Republic of China
| | - Hongmin Yu
- School of Public Health, Xuzhou Medical University, Xuzhou, People's Republic of China
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Sanabria A, Shah JP, Medina JE, Olsen KD, Robbins KT, Silver CE, Rodrigo JP, Suárez C, Coca-Pelaz A, Shaha AR, Mäkitie AA, Rinaldo A, de Bree R, Strojan P, Hamoir M, Takes RP, Sjögren EV, Cannon T, Kowalski LP, Ferlito A. Incidence of Occult Lymph Node Metastasis in Primary Larynx Squamous Cell Carcinoma, by Subsite, T Classification and Neck Level: A Systematic Review. Cancers (Basel) 2020; 12:cancers12041059. [PMID: 32344717 PMCID: PMC7225965 DOI: 10.3390/cancers12041059] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Larynx cancer is a common site for tumors of the upper aerodigestive tract. In cases with a clinically negative neck, the indications for an elective neck treatment are still debated. The objective is to define the prevalence of occult metastasis based on the subsite of the primary tumor, T classification and neck node levels involved. Methods: All studies included provided the rate of occult metastases in cN0 larynx squamous cell carcinoma patients. The main outcome was the incidence of occult metastasis. The pooled incidence was calculated with random effects analysis. Results: 36 studies with 3803 patients fulfilled the criteria. The incidence of lymph node metastases for supraglottic and glottic tumors was 19.9% (95% CI 16.4–23.4) and 8.0% (95% CI 2.7–13.3), respectively. The incidence of occult metastasis for level I, level IV and level V was 2.4% (95% CI 0–6.1%), 2.0% (95% CI 0.9–3.1) and 0.4% (95% CI 0–1.0%), respectively. For all tumors, the incidence for sublevel IIB was 0.5% (95% CI 0–1.3). Conclusions: The incidence of occult lymph node metastasis is higher in supraglottic and T3–4 tumors. Level I and V and sublevel IIB should not be routinely included in the elective neck treatment of cN0 laryngeal cancer and, in addition, level IV should not be routinely included in cases of supraglottic tumors.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín 050010, Colombia;
- CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín 050021, Colombia
| | - Jatin P. Shah
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.P.S.); (A.R.S.)
| | - Jesus E. Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA;
| | - Kerry D. Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN 55902, USA;
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 32952, USA;
| | - Carl E. Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ 85259, USA;
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, 33011 Oviedo, Spain; (J.P.R.); (A.C.-P.)
- University of Oviedo-IUOPA, 33011 Oviedo, Spain
- Head and Neck Cancer Unit, CIBERONC, 28029 Madrid, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, 33011 Oviedo, Spain;
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, 33011 Oviedo, Spain; (J.P.R.); (A.C.-P.)
- University of Oviedo-IUOPA, 33011 Oviedo, Spain
- Head and Neck Cancer Unit, CIBERONC, 28029 Madrid, Spain
| | - Ashok R. Shaha
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.P.S.); (A.R.S.)
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, FI-00029 HUS Helsinki, Finland;
| | | | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands;
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, SI-1000 Ljubljana, Slovenia;
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium;
| | - Robert P. Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands;
| | - Elisabeth V. Sjögren
- Department of Otolaryngology—Head and Neck Surgery, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands;
| | - Trinitia Cannon
- Department of Head and Neck Surgery and Communication Sciences, Duke University Health System, Durham, NC 27609, USA;
| | - Luiz P. Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, 01509-900 São Paulo, Brazil;
- Department of Head and Neck Surgery, University of São Paulo Medical School, 05402-000 São Paulo, Brazil
| | - Alfio Ferlito
- International Head and Neck Scientific Group, 35100 Padua, Italy
- Correspondence:
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Shi Y, Zhou L, Tao L, Zhang M, Chen XL, Li C, Gong HL. Management of the N0 neck in patients with laryngeal squamous cell carcinoma. Acta Otolaryngol 2019; 139:908-912. [PMID: 31343387 DOI: 10.1080/00016489.2019.1641219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Neck lymph node status is the chief prognostic index in patients with head and neck squamous cell carcinoma (SCC), yet the management of a clinically negative neck in this setting is still controversial, especially in patients with laryngeal SCC (LSCC). Objectives: To evaluate the efficacy of selective neck dissection (SND) to control occult disease in patients with LSCC and clinically negative (cN0) necks. Materials and methods: Medical records of 1476 patients with cN0 LSCC were analyzed. In conjunction with primary treatment, 126 (8.5%) underwent at least unilateral elective neck dissection, whereas most 1350 (91.5%) followed a wait-and-see protocol. Prognostic significance was indicated by the Kaplan-Meier survival estimates. Results: The rate of occult neck disease was 15%. Five-year overall and disease-free survival rates were 74.4% and 66.7%, respectively. Prognosis was closely related to T stage, preoperative tracheotomy, and postoperative recurrence. There was no significant correlation with age, sex, or preoperative neck dissection; but in patients with supraglottic LSCC, the relation between prognosis and preoperative neck dissection was significant, with fewer neck and local recurrences than the wait-and-see group (p < .05). Conclusions and significance: Selective neck dissection is serving as an accurate prognostic tool in patients with supraglottic laryngeal cancers.
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Affiliation(s)
- Yong Shi
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Xiao-Ling Chen
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Cai Li
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Hong-Li Gong
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
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6
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Ma H, Lian M, Feng L, Li P, Hou L, Chen X, Huang Z, Fang J. Factors contributing to lymph node occult metastasis in supraglottic laryngeal carcinoma cT2-T4 N0M0 and metastasis predictive equation. Chin J Cancer Res 2015; 26:685-91. [PMID: 25561766 DOI: 10.3978/j.issn.1000-9604.2014.12.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/16/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To investigate factors that contribute to lymph node metastasis (LNM) from clinical cT2-T4 N0M0 (cN0) supraglottic laryngeal carcinoma (SLC), and to predict the risk of occult metastasis before surgery. METHODS A total of 121 patients who received surgery were retrospectively analyzed. Relevant factors regarding cervical LNM were analyzed. Multivariate analyses were conducted to predict the region where the metastasis occurred and prognosis. RESULTS The overall metastatic rate of cN0 SLC was 28.1%. Metastatic rates were 15.4%, 32.5% and 35.7% for T2, T3 and T4, respectively. Metastatic rates for SLC levels II, III and IV were 19.6%, 17.2% and 3.6%, respectively. A regression equation was formulated to predict the probability of metastasis in cN0 SLC as follows: Pn=e((-3.874+0.749T3+1.154T4+1.935P1+1.750P2))/[1+e((-3.874+0.749T3+1.154T4+1.935P1+1.750P2))]. Approximately 0.2% of patients experienced LNM with no recurrence of laryngeal cancer. Comparison of the intergroup survival curves between patients with and without LNM indicated a statistically significant difference (P=0.029). CONCLUSIONS Cervical lymph node metastatic rates tended to increase in tandem with T stage in patients with LNM in cN0 SLC, and neck dissection is advised for these patients. Moreover, cervical LNM in cN0 SLC showed a sequential pattern and may be predicted.
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Affiliation(s)
- Hongzhi Ma
- 1 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China ; 2 Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing 100005, China ; 3 Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing 100730, China
| | - Meng Lian
- 1 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China ; 2 Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing 100005, China ; 3 Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing 100730, China
| | - Ling Feng
- 1 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China ; 2 Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing 100005, China ; 3 Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing 100730, China
| | - Pingdong Li
- 1 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China ; 2 Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing 100005, China ; 3 Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing 100730, China
| | - Lizhen Hou
- 1 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China ; 2 Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing 100005, China ; 3 Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing 100730, China
| | - Xiaohong Chen
- 1 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China ; 2 Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing 100005, China ; 3 Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing 100730, China
| | - Zhigang Huang
- 1 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China ; 2 Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing 100005, China ; 3 Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing 100730, China
| | - Jugao Fang
- 1 Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China ; 2 Key Laboratory of Otorhinolaryngology Head and Neck Surgery, Ministry of Education, Beijing Institute of Otorhinolaryngology, Beijing 100005, China ; 3 Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing 100730, China
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